By Dave Gessel
The following is a review of some of the legislation discussed at this year's Utah State Legislature that affects hospitals.
Strong Legislative Session for Utah’s Hospitals and Health Systems!
The 2018 session was a challenging and productive session for Utah’s hospitals and health systems. Thanks to the UHA Board, UHA Government Relations Committee and UHA members and lobbyists who all worked together to make this happen.
Substantial Increase in Medicaid Funding for Hospitals
UHA worked with our legislative allies to successfully obtain over $96 million in new state and federal Medicaid funding. This includes a 2% increase for hospitals and ACOs for the coming year. This will allow hospitals and Medicaid ACOs to continue to work together in treating Medicaid patients. This amounts to tens of millions in new funding for the coming fiscal year that hospitals and health systems should be aware of as they negotiate new contracts with ACOs this coming year.
Medicaid Expansion Legislation Passes
After many years of discussion and debate, a significant expansion of Medicaid to cover those up to 100% of the federal poverty level passed the Legislature. H.B. 472 – Medicaid Expansion Revisions will initially reposition current state funds to begin the expansion for an estimated 70,000 Utahns beginning in fiscal year 2020. Additional funding over time would come from a new hospital assessment estimated to be no more than $8 million in 2024, when this funding would end without further legislative enactment. This bill does authorize up to $25 million in this new hospital assessment if needed over time. It is estimated that over $400 million of new federal funds would come to Utah under this bill, if approved. However, there are a number of issues that the federal government must approve before any of this would happen. The state must submit a Medicaid waiver for approval that would include a work requirement, a cap on state funding for the program and approval for obtaining the 90/10 federal match at the level of 100% of the federal poverty level. UHA will work with the state to make sure the waiver proposal protects the interest of hospitals and health systems.
Other Medicaid Legislation
There were a number of other bills that passed impacting Medicaid. The most prominent is H.B. 325 – Primary Care Network Amendments that will expand the Primary Care Network to add more individuals and for the first time include hospital inpatient and outpatient services and physician specialist care as benefits in this program. This bill must also receive a waiver from the federal government. It would require no new state funding but would use existing state funds already approved. This waiver would only be pursued if the broader Medicaid expansion bill mentioned above is not approved. H.B 12 – Family Planning Services Amendments passed and will provide Medicaid funding for women who would like to use Long Acting Reversible Contraceptives or LARC’s. For the first time Medicaid would pay for this service. H.B. 42 – Medicaid Waiver for Mental Health Crisis Services passed and seeks a waiver to provider more funding for mental health coverage for Medicaid recipients. Bills dealing with full Medicaid expansion, additional Medicaid waiting periods and other Medicaid waiver bills did not pass. S.B. 172 – Medicaid Waiver Amendments also did not pass and this bill sought federal approval for a Medicaid block grant and other substantial changes in the Medicaid program.
New Funding to Educate More Nurses
UHA joined with a coalition to help secure over $2 million in new annual funding for state colleges and universities to educate more than 100 new nurses each year. Additional funding could come from each university or college president depending on how they prioritize nursing in their workforce efforts that received a total of over $9 million in new funding. S.B. 147 – Nursing Initiative passed and provides a new process to fund these programs as well as require the Utah Medical Education Council to more effectively project workforce demand in the future.
Other Important Funding Impacting Hospitals and Health Systems
There were many other positive funding areas for hospitals and health systems this session. UHA secured $250,000 in funding for Get Healthy Utah to continue its population health initiative. The UHA-sponsored Rural Physician Loan Repayment program continues to be fully funded at $300,000 but we did not receive any new funding as requested and will continue to press for that in the future. In addition, another $250,000 was funded to help repay loans for doctors, nurses and other mid-level professionals who work in rural or urban underserved areas. This funding will allow rural hospitals to recruit and help get loan repayments for a variety of staff. In addition, the Legislature continued funding for the rebuild of the University of Utah Medical School as well as additional funding of over $3 million to fund H.B. 41 - Mental Health Crisis Line Amendments. In addition, $250,000 was funded for a new Graduate Certificate in Rural Medicine at the University of Utah School of Medicine to recruit more future physicians to work in rural Utah. S.B. 150 – Utah Statewide Stroke and Cardiac Registry Act passed and provides $100,000 to the Department of Health to collect and analyze data to improve care in these areas. Finally, $250,000 was appropriated to begin the Pediatric Trauma and Quality Improvement Network which was previously approved but not funded.
Workers Compensation Legislation Passed
S.B. 64 – Workers Compensation Health Care Amendments passed after challenging negotiations. This bill will maintain the law to pay rural hospitals in fourth, fifth and sixth class counties at 85% of billed charges but reduces the payment for hospitals in larger counties to 75% of billed charges. In addition, the bill will place a hospital representative on the Workers Compensation Advisory Committee and also authorize a study on hospital reimbursement. This will be a multiyear effort to find the appropriate level of payment for providing care to injured workers.
Surprise Billing Legislation Does Not Surface This Session
Due to the efforts of UHA and many of its members, legislation to address “surprise” balance billing in the emergency room setting did not come out this session. Thanks to all who worked so hard to educate the legislature on the complexity and challenge of this issue. Hospitals were proactive in trying to find solutions and share appropriate information that helped immensely on this issue.
Other Health Care Bills That Passed of Interest To Hospitals
H.B. 43 – Blood Testing Amendments passed and requires an appropriate warrant for law enforcement to draw blood in hospitals. This bill was in response to the problem that occurred last year in the inappropriate arrest of a nurse for refusing to do a blood draw without an appropriate warrant. H.B. 204 – Health Care Debt Collection passed and improves upon a similar bill that passed last year. This new law should make it easier for health care providers to comply with this law. S.B. 217 – Physician Testing Amendments passed and will require any physician competency testing to reflect nationally recognized standards adopted by the American Medical Association. Since the AMA has not yet adopted these standards, the bill does not become effective until they do or on July 1, 2019. H.B. 417 – Federal Grants Management Amendments also passed and provides new guidance for the Medicaid Upper Payment joint program between locally owned government hospitals and nursing homes. H.B. 322 – Non Emergency Patient Transportation Safety Amendments passed in the last minutes of the Legislature and was a controversial compromise between the Department of Health, fire and paramedic agencies, private ambulances and other private medical transport providers. This legislation will require a clarifying rule by the Department of Health to implement. Finally, S.B. 223 – Utah Health Care Malpractice Act Amendments passed and made minor changes to the pre-litigation panel process, including requiring a physician of the same specialty certifying the case.
Bills that Did Not Pass of Interest to Hospitals
UHA was instrumental in stopping a number of bills that would have been detrimental to hospitals and health systems. UHA helped to stop H.B. 199 – Division of Substance Abuse and Mental Health Amendments which did not pass and would have made major changes in funding in these areas potentially detrimental to hospitals. UHA actively worked with the broader business community to defeat H.B. 359 – Allocation of Fault Amendments that would have changed settled Utah law for many years and would have made a hospital or business fully liable for an entire judgment even if they were only 1% at fault rather than the current system of only having to pay the part of the judgment that a jury or judge allocated to each defendant. H.B. 405 – Charity Health Care Amendments also did not pass and would have impacted every non-profit hospital and other non-profit health care entities. H.B. 425 – Physician Certification did not pass and would have had a major impact on hospitals and insurers who use board certification as part of their credentialing process.
Other Legislation of Interest
There were many bills dealing with a variety of issues for healthcare. Pharmacists, physician assistants and physical therapists all had changes to their licensing statutes. Five bills dealing with marijuana use and research passed this session. One bill dealing with abortion passed and one did not. Bills taxing and regulating tobacco did not pass. Please review the attached bill list for more information on each of these changes.
Looking Ahead to 2018-19 Policy Issues
The major issue of the next year will be appropriate engagement as directed by the UHA Board in all of the proposed Medicaid waivers to expand Medicaid. Maintenance of Certification for physicians will also be discussed further. Additional efforts on nurse education funding and rural physician loan repayment funding will continue as well. Reauthorization of our main hospital assessment will be necessary next session.
UTAH HOSPAC Golf Tournament in June!
One of the best ways to support UTAH HOSPAC, our political action committee, is our annual golf tournament that will be held once again at Thanksgiving Point on Monday, June 11, 2018. We encourage each hospital to provide a foursome at the tournament as that goes a long way for most hospitals in meeting their annual HOSPAC goal. Look for additional information soon on the golf tournament as well as other opportunities to contribute to UTAH HOSPAC.
2018 Is Big Election Year for State Legislative Races and Issues
All Utah House members and half of the Utah Senate will be up for election this coming November. An unusual amount of change; up to 30% or more turnover in legislators is projected. This means that every hospital needs to be active in knowing and working with their new legislators. UHA is ready to assist any hospital in this regard if they reach out for help. We will have new Senate and House leadership teams as well next year. In addition, all four U.S. Congressional seats and a U.S. Senate seat are up for election this fall. Finally, there is a possibility that a full Medicaid Expansion Initiative will be on the ballot as well as a marijuana ballot initiative. This is a major year for hospitals to be actively involved in supporting good legislators!
UHA Is Here to Help and Serve
UHA is here to help you with any of your legislative questions or concerns. Please review the attached list of bills for additional information. If you need even more bill or legislative information, you can go to the legislative website at www.le.state.ut.us where you can read the legislation that passed this session. If you have specific questions or concerns, please e-mail Dave Gessel at and he would be happy to help you. He would also be happy to come and brief your board or staff on the legislative session. Thank you for your support of UHA and Utah’s hospitals and health systems.